ADHD/ADD is probably
the most researched condition in the neurofeedback literature. As any parent of a child with ADHD, or any adolescent or adult
with ADHD knows, the major difficulty is focusing and sustaining attention in certain situations in which attention is important.
The individual with ADHD can be distracted by things outside him or herself or by his or her own thoughts, can have difficulty
initiating tasks or can have problems completing what he or she started. It can be hard to maintain a conversation, or sit
still, or control one’s impulses. These problems can cause major difficulties at work, at school, and with one’s
spouse, parents, children and friends.

ADHD/ADD is a biological condition that affects the ways in which the brain
transmits information. It affects the electrical and chemical signals within the brain. While it is important for the individual
with ADHD/ADD to learn how to manage his or her attention better, and for parents and teachers to learn effective ways to
help the individual attend and be productive, it is also important to work with the underlying neurobiology. The electrical
signals in the brain get transmitted at different speeds or frequencies. These frequencies help determine our mental
state at any moment and affect the chemical signals that the brain transmits. They range from very slow frequency activity
in sleep states, known as delta waves, to somewhat faster, but still slow activity in semi-awake states, know as
theta waves, to more relaxed but not outwardly attentive states, dominated by alpha waves, to more engaged
and attentive states characterized by beta wave activity. In order to focus and sustain our attention, there
needs to be sufficient beta activity in and around the frontal lobes, and the inhibition of slow wave activity, such as theta
and alpha, in the same brain region. The frontal lobes are known as the executive parts of the brain, because they are involved
with coordinating and integrating all the other parts of the brain through processes such as attending, planning, organizing,
inhibiting, delaying, controlling our emotional responses, considering long-term consequences, and considering alternative
meanings of information and alternative courses of action. There are other parts of the brain that also seem important in
regulating attention, such as the right parietal lobe, toward the back of the brain, and these brain areas might be more important
in attention problems in some people. When
a person is presented with a learning or academic task, the brain normally inhibits slow wave activity, such as theta or alpha,
and produces more beta activity, because the slow activity makes the brain inefficient and the beta activity makes the brain
come more “on line” in engaging with an external task. In ADHD/ADD, the brain may do the opposite and instead
produce even more slow activity and inhibit beta activity. The brain, in other words, goes more “off line” when
presented with an academic task or a challenge which does not provide the individual with immediate stimulation, as does a
video game or something fun. This
is a common pattern seen in ADHD/ADD, but there are other patterns of brain wave activity that also occur. For example, there
might be a problem with how different parts of the brain are connecting or communicating with each other. For these reasons,
a quantitative electroencephalogram (qEEG) or brain map might be helpful in sorting out exactly what brain wave abnormalities
are involved with each individual. In
neurofeedback treatment for ADHD/ADD, we monitor the individual’s brain wave state or EEG in a comfortable and painless
way while the individual sits in a comfortable chair and “plays” a video game-like exercise which is controlled
by his or her brain wave activity. For example, the exercise can be set up so when the individual’s brain wave activity
shows that he or she is increasing beta activity and inhibiting theta, or another form of slow wave activity, the individual
earns points in the “game” and the action on the screen advances. When the brain wave activity gets out of the
desired pattern, the action in the game stops, and the brain then has to find a way to get back into the desired pattern to
earn more points. The brain does this unconsciously through the individual attending to the visual and auditory feedback that
is provided when succeeding at the game. This is like exercise for the brain, and the brain learns to produce this pattern
on its own.

Research has shown that neurofeedback
training produces benefits equivalent to those produced by stimulant medication. Follow up studies have found that, unlike
with medication, these benefits tend to last. There have been studies that have indicated benefits lasting for years. Furthermore,
there have not been significant side effect risks reported in the literature.

Of course, no treatment works for everyone and there is always a potential risk of unwanted effects
in any form of treatment. That is why we encourage you to discuss this treatment with someone knowledgeable about the scientific
studies and the clinical applications of neurofeedback so you can make an informed choice for yourself or your child.

Studies dealing with the underlying brain mechanisms of ADHD and the use
of neurofeedback for ADHD/ADD are the following:

Monastra, VJ, and Monastra DM (2004). EEG biofeedback treatment for ADHD: an analysis
of behavioral, neuropsychological, and electrophysiological response over a three-year follow-up period. Presented at the
Annual Conference of the Association for Applied Psychophysiology and Biofeedback. Colorado Springs: April 2, 2004.